Risk ‐ Adjusted Utilization Index
Utilization (amount of functional status change per visit) can be risk ‐ adjusted by taking advantage of a risk ‐ adjusted 3x3
value ‐ based purchasing table
‐ an average "weighted / distribution" of the Functional Status Change to Visits.
In the table, risk ‐ adjusted residuals of functional status change are divided by percentiles into low (i.e., lowest third or worst outcomes), expected (i.e., middle third) and high (i.e., highest third or best outcomes), and risk ‐ adjusted residuals of number of treatment visits are divided by percentiles into fewest (i.e., lowest third or fewest number of visits),
expected (i.e., middle third) and more (i.e., highest third or most number of visits).
With Functional Status (FS) change in 3 rows (highest on top) and visits in 3 columns (fewest on left), a 3 X 3 table is created where those with better than predicted FS change treated in fewer than predicted visits are in cell 1 in the upper left corner, and those with worse than predicted FS change treated in more than predicted visits in cell 9 in the lower right corner.
Clinically, you would not want to be a patient in cell 9 (lower right corner) where your outcomes were worse than predicted with a higher number of visits, but you would prefer to be in cell 1 (upper left corner) where your outcomes were better than predicted and delivered in the fewest
number of visits.
Once each patient is placed in one of the 9 cells in our 3 X 3 table, a score is created for the unit being analyzed, such as the clinic or clinician, that represents a risk ‐ adjusted utilization index from which the risk ‐ adjusted percentile ranking is calculated.
Clinic A’s patients were scored using the 3x3 value table.
Then, the percentage of patients for the Unit that fell into the
High cells (1,2 and 4), Expected cells (3,5 and 7) or Low cells
(6, 8 and 9) is calculated.
The percentage of patients in each grouping is then multiplied by the weight for each grouping, to establish the weighted sum of the total of all 3 weighted scores.
Please note that the weighted sum ranges are from 0.17
and all scores will be rounded on the quarterly profile
report to two decimal points.
It is the weighted sum that is compared with all other user weight sums to determine the national utilization percentage ranking for each unit, using the 0.17
A minimum of forty (40) complete discharged episodes for the rolling 12 months (or 10 per quarter) is required to receive a percentile ranking.
An estimated percentile rank is provided if the complete discharged episodes do not meet the minimum criteria, noted by an asterisk (*) in the
percentile rank cell.
This information is included on the
Quarterly Profile Reports and on the Scorecard
in the Report Portal.
On the Profile Reports,
Utilization is surfaced on each body part impairment page,
showing the percentage of patients in each of the 3 categories, the weighted sum, and the national percentile ranking this weighted sum represents in
the National database for the rolling 12 month period.
On the Scorecard
, to provide you with an At ‐ A ‐ Glance reference to the Utilization Index, the HIGH Utilization
Column is Highlighted to designate if the percentage of your patients falling into the HIGH Category is lower than the percentage of patients falling into the LOW Category.
The goal is to have the majority of your patients falling into the
HIGH and EXPECTED utilization category.